Chester Cnty. C.P. Rule 1915.15 Form

________________________ : IN THE COURT OF COMMON PLEAS

Plaintiff: CHESTER COUNTY, PENNSYLVANIA

vs. : NO.

________________________ : CIVIL ACTION - LAW

Defendant: IN CUSTODY

NOTICE AND ORDER TO APPEAR

You _______________________, defendant, have been sued in court to obtain/modify

custody of the child(ren):

______________________________________________________________________

You are hereby notified of the following:

1. Court Ordered Mediation: you are ordered to contact the Mediator assigned to your

case within three (3) days of receiving these papers to schedule mediation orientation.

Mediator: __________________________ Phone: ____________________

Failure to contact the mediator and attend mediation orientation may result in sanctions,

including, but not limited to, a fine of up to $100, delay in your custody proceedings or other

appropriate sanction.

2. Custody Conciliation Conference: You are ordered to appear in person at the Chester

County Justice Center, 5th Floor, Hearing Room 5206, 201 West Market Street, West Chester PA

19380 for a Custody Conciliation Conference on ____________________, at ________ ____.m. at

which time a recommendation for a custody Order may be entered.

If you fail to appear, an order for custody may be entered against you or the court may

issue a warrant for your arrest.

3. Parenting Class:

a. You, _________________________, Plaintiff, are ordered to appear in person to attend a

Parenting Class on Thursday, ____________________ at 4:30 p.m. in Room 4112, Fourth Floor

Chester County Justice Center 201 West Market Street, West Chester, PA.

b. You, _________________________, Defendant, are ordered to appear in person to attend

a Parenting Class on Thursday, ____________________ at 4:30 p.m. in Room 4112, Fourth Floor

Chester County Justice Center 201 West Market Street, West Chester, PA.

Failure to attend your parenting session as scheduled may

affect your rights to custody, partial custody or visitation.

4. You must file with the Court a verification as required by Pa.R.C.P. 1915.3-1 in the form

attached regarding any criminal record or abuse history regarding you and anyone living in your

household within thirty days of the service of the within complaint or petition on you, but not later

than the custody conciliation conference scheduled in Paragraph 2, above.

No party may make any change in the residence of any child which significantly impairs

the ability of the other party to exercise custodial rights without first complying with all the

applicable provisions of 23 Pa.C.S. §5337 and Pa.R.C.P. 1915.17 regarding relocation.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT

HAVE A LAWYER, PLEASE CONTACT THE OFFICE SET FORTH BELOW:

Lawyer Referral Service

15 West Gay Street

West Chester, PA 19380

610-429-1500

IF YOU CANNOT AFFORD A LAWYER,

PLEASE CONTACT THE OFFICE SET FORTH BELOW:

Legal Aid of Southeastern Pennsylvania

Chester County Division

222 North Walnut Street, 2nd Floor

West Chester, PA 19380

610-436-4510

AMERICANS WITH DISABILITIES ACT OT 1990

The Court of Common Pleas of Chester County is required by law to comply with the

Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable

accommodations available to disabled individuals having business before the court, please contact

Family Court Administration at 610-344-6405. All arrangements must be made at least 72 hours

prior to any hearing or business before the court. You must attend the scheduled conference.

Date: ____________________ BY THE COURT:

_________________________

: IN THE COURT OF COMMON PLEAS

___________________ : CHESTER COUNTY, PENNSYLVANIA

Plaintiff:

vs. : NO.

__________________ :

Defendant

:

: CIVIL ACTION - CUSTODY

AFFIDAVIT PURSUANT TO 23 Pa.C.S.A. §5328 and §5329

I _________________________, hereby swear or affirm that:

(print name)

1. Please state whether or not you and/or another adult living in your household have been

convicted of, pled guilty or no contest to the following crimes in Pennsylvania or any other jurisdiction, as

follows:

Adult in my Date Of

Me

NO YES Household Conviction

□ □ Contempt for violation of a □ □

Protection from Abuse Name:________________________ _______

order or agreement;

□ □ Driving under the Influence □ □

of alcohol or a controlled Name: _______________________ _______

substance or drugs;

□ □ Possession, sale, delivery, □ □

manufacturing or offering Name: ______________________ _______

for sale any controlled

substance or other drug or

device;

□ □ Criminal homicide; Murder; □ □

Name: _______________________ _______

□ □ Aggravated Assault; □ □

Name: _______________________ _______

□ □ Stalking; □ □

Name: _______________________ _______

□ □ Kidnapping; □ □

Name: _______________________ _______

□ □ Unlawful restraint; □ □

Name: _______________________ _______

□ □ False imprisonment; □ □

Name: _______________________ _______

□ □ Luring a child into a motor □ □

vehicle or structure; Name: _______________________ _______

____________________

Adult in my Date Of Me NO YES Household Conviction

□ □ Rape, statutory sexual □ □

assault, involuntary deviate Name: _______________________ _______

sexual intercourse, sexual

assault, aggravated indecent

assault, indecent assault,

indecent exposure, sexual

abuse of children, sexual

exploitation of children,

sexual intercourse with an

animal, incest;

□ □ Sex offender non- □ □

compliance with Name: _______________________ _______

registration requirements,

statute, court order,

probation or parole, or other

requirements under 18 Pa.

C.S.A. §3130 and 42 Pa.

C.S. §9795.2;

□ □ Arson and related offenses; □ □

Name: _______________________ _______

□ □ Concealing death of a child; □ □

Name: _______________________ _______

□ □ Endangering the welfare of □ □

children; Name: _______________________ _______

□ □ Trading, bartering, buying, □ □

selling or dealing in infant Name: _______________________ _______

children;

□ □ Prostitution and related □ □

offenses; Name: _______________________ _______

□ □ Obscene and other sexual □ □

materials and performances; Name: _______________________ _______

or

□ □ Corruption of minors or □ □

unlawful contact with a Name: _______________________ _______

minor.

2. Please state whether or not you and/or another adult living in your household have a present and/or past

history involving violent or abusive conduct as follows:

Adult in my Date Of

NO YES Me Household Finding

□ □ A finding of abuse by a □ □

Children & Youth Agency or Name: _______________________ _______

similar agency in

Pennsylvania or similar

statue in another jurisdiction

□ □ Has been subject to a □ □

Protection from Abuse order Name: _______________________ _______

in Pennsylvania or similar

statute in another jurisdiction

□ □ □ □Other:

Name_______________________ _______

I verify that the statements made in this affidavit are true and correct. I understand that any false statements

herein are subject to the penalties of 18 Pa.C.S.A. §4904 relating to unsworn falsification to authorities.

_________________________

Signature

_________________________

Printed name